Provider Demographics
NPI:1558321232
Name:MYERS, DEANNA LYN (ATC)
Entity Type:Individual
Prefix:MRS
First Name:DEANNA
Middle Name:LYN
Last Name:MYERS
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3803 W US HIGHWAY 224
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IN
Mailing Address - Zip Code:46733-7502
Mailing Address - Country:US
Mailing Address - Phone:260-547-4695
Mailing Address - Fax:
Practice Address - Street 1:1000 E NORTH ADAMS DR
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IN
Practice Address - Zip Code:46733-2739
Practice Address - Country:US
Practice Address - Phone:260-724-7121
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36000635A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist